Wednesday, October 31, 2018

A Twee Update


Twee playing

For anyone not following me on Facebook, Twee is doing very well. I am guardedly optimistic that we are going to pull her out of this.

After a short time of force feeding her, her quality of life declined dramatically. She did not fight me or give me any indication that she hated the feeding (well except when the food was too liquid) so my husband and I both started believing that whatever was wrong was getting worse. She was avoiding and isolating.

We had a discussion of what we can do and what we should do. The vet recommended an ultrasound to see what we were dealing with. There was no one local who could do it quickly so we were looking at having to travel an hour or two to find one. Twee travels okay but we weren't thrilled with the idea of traveling hours on end to only find that she was at the end of her life and having to put her down there. Most of the treatment for the issues we were facing included sedation which Twee has never handled well - to put it mildly. She stopped breathing the last time we sedated her, so we ran the risk of attempting to fix what was going on and having her die on the table or in recovery. Neither one of us liked the idea of not being with her until the end.

We looked at Twee and what she was telling us. We looked at our options and came to the conclusion that this was most likely a life ending event and we would be kind and be with her and let her go with love and care.

We got to the clinic and Twee perked right up. She investigated the entire room, jumped up on the couch and snuggled with my husband who later said "she told me she was not ready to go". The vet was incredibly kind and worked with us to help us make the next few decisions. She told us, and I knew full well, that this could be an adrenaline rush or just the end of life rally, but my husband no longer agreed that this was her time. I had the vet examine her to see if she was painful and she appeared not to be, so we made the decision to go down to Angell to get an ultrasound.

We did have a few other options, but we were looking at going to Massachusetts anyway, and we have friends in Boston, so we opted for that.

We got there at three in the afternoon and were not seen until after five. An intern talked to us for a short while, looked over the notes from her previous exam and blood work and said they would have to admit her. I was not happy. My husband was okay with this so this is what we did.

They kept her overnight on fluids and did not force feed her despite my informing them she had not eaten since last night and my asking that they feed her.

The intern called us to give us an update in the morning and told us that they still had not force fed her but assured me that she was getting nutrition through the fluids. They called me that afternoon and told me that the ultrasound showed inflammation in her liver, gallbladder and pancreas. She talked at me, not to me. When I asked questions beyond what was on the script of what she told me originally, she just reiterated what she had originally said and would not speculate or said that is for the other vet to determine.

She eventually started eating on her own. She vomited initially but continued to eat and kept it all down. It was recommended that she stay until Monday but both of us work and my husband was going to be four hours away from Boston that morning and that was going to be a lot of driving for him. We asked if it would be okay if we picked her up that night (Sunday) and the vet didn't say it would be a bad idea, so we went and got her. We got down there at eight pm and were told to wait in the lobby for someone to go over the discharge instructions and get us the meds.

Well, *sigh* they sent out a tech who was unfamiliar with her case who simply read the discharge instructions back to me. I looked at the bill and saw a double charge and mentioned it and she didn't believe it was possible so I had her check and I was right. Then she went over the meds - most of which were liquids, which I had mentioned on intake that she didn't do well with because force feeding her ruined her quality of life. I didn't think to refuse them and ask for pills because I was emotionally and physically exhausted, the pharmacy was closed and the tech didn't ask if liquid was okay. I should probably make it clear that we were in the lobby.. we didn't get to go into a room and have a serious talk with anyone.. I couldn't even really hug her when she finally got to us because we were in the lobby and taking her out of the carrier was a very bad idea. Whoever decided this is their protocol... well, it is a very bad idea for cats..

I was given a pain medicine despite no one mentioning she was in pain. (remember the exam at the vet up here didn't show a pain response) and two antibiotics despite not being told that they showed an obvious sign of infection or a reason for them. I asked if they meant to have two antibiotics and the tech that released her to us simply said yes, she didn't ask for clarification from anyone. Let me remind you that we already had an error on the bill.. I admit that having several organs inflamed must be uncomfortable, but painful? *shrug* I mean I accept that is a serious possibility and most likely in a lot of cases, but Twee isn't a statistic, she is a cat dealing with a health issue.. did *she* need pain meds??

I am angry with myself that I didn't challenge more. I am angry that I didn't demand to talk to someone who dealt with her, but it was late on a Sunday and who knew who was still there, who knew if it was an option. and I was exhausted..

I refused to take the meds I already had (again, they didn't talk to me about what she needed just dispensed it) and took everything else and came home.

Twee was so happy to be home. I gave her the pill that needed to be given on an empty stomach (why they didn't give it at the clinic, I have no idea) and we needed to wait an hour to feed her. She sat by the food plates looking like she was waiting for dinner, which killed me. We decided to engage her in play and she was incredibly playful! It made us so happy.

I pulled out a few food options and made her a tasting plate and set her up in the guest room. When we were ready to feed her I pulled out the liquid med for that evening and gave it to her and she hated it.. she became depressed. My husband slept in the guest room with her to see how she did and he reported she did well but didn't jump on the bed and snuggle with him. Her food of choice? Dry food *smh* but she didn't start eating until much later in the evening.

In the morning, I had the three liquid meds to give her. It was horrible. She took them well enough but started drooling and avoiding me and wouldn't even let me wipe the drool off her face. My heart and my spirit broke. I talked to my local vet and we talked about what I was giving her and what options we had. There were pill forms and injectable forms for everything she was on and the vet felt the same way as I did about two antibiotics and said she most likely would have only rx'd one but both wasn't a bad idea, and obviously it was my call.

My husband was due to come home before the vet closed, so I waited for him to see what he wanted to do. Twee is very much his kitty and I wanted him to make the final call. He was scared that all the medication was going to ruin her quality of life and the stress of it all was going to be worse than the medication. He decided to forgo both of the antibiotics and pain meds. I reluctantly agreed. I abhor stopping antibiotics before the course as you seriously risk making super bugs, but she only got one dose as far as I could tell. Not to mention that there was a chance that infection started this or an infection resulted from it we wouldn't be treating the cause.. I could only cross my fingers that we wouldn't wake up in the morning to seriously regret the decision. It was a very long and hard night for me.

Tuesday morning came and she was bright and happy and eating and put on some weight. I gave her some fluids. I offered her more food and watched her try to eat the small kibbles of the dry food I had on hand for the foster kittens. It was such a production that I had to go out and buy a bag of dry for her *shudder*. I had a feeling that as soon as I did she would start eating the raw with The Crew (and wouldn't you know it she did) but honestly, I was okay with that because I can give the rest of the bag to the fosters.

I was still waiting for the other shoe to drop. Not following the vet's instructions on a situation I really knew nothing about scared me. All I knew for sure was what I was told during the calls and my own intuition. I think the inflammation started from her not eating and the stress of losing Jack. It was my belief all along that if we could just get enough calories in her and rehydrate her that she would bounce back. What rational reason did I have for that? none. Not a single one. I'm not a vet, I don't play one on the internet or in real life. I only know what I felt, what I saw, and what I know about her..

So this is what we are doing. I am giving her the "liver protectent" that they recommended because I really liked the idea of giving milk thistle and this medication is derived from that. I probably would have preferred to give her actual milk thistle, but I own this now so I am giving it. I am giving her the appetite stimulate for a few more days and when I was snuggling her this afternoon her stomach was gurgling a little so I thought what the heck I have Cerenia I will give that too on the off chance she is nauseous, which Angell rx'd but I had on hand from Jack, despite not seeing any indications of that other than the initial vomit which the intern who called me said was most likely from eating too fast. I'm also giving CBD since that involves two drops instead of the huge amount of liquid that the other pain meds required.

So, either we are making the biggest mistake ever and things are going to go horribly wrong or she is going to continue to improve. Since she is up over nine pounds tonight (her original fighting weight is nine and a half pounds and her weight when we took her to the vet was eight and a half) I am cautiously optimistic.

I did receive a call from Angell today about her B levels and was told her folate levels were low.. the vet who called said the vet in charge of her case would like to see her in a couple of weeks for a follow up and I told her - since the information never seems to make it to anyone - that I was two hours away and that was unlikely. She replied with an "oh, two hours away..". I continued with "and I was so unhappy with the service I received and the lack of communication (because the notes that my vet got said IBD and intestinal issues despite no one mentioning that to me among a few other things) and the woman could not get off the phone with me fast enough.

Angell's reputation is very good but I felt like I was not a pet owner or pet parent just the human that came along with the case who had to be dealt with. I did not once felt they cared about me or even Twee (although they did make it a point to tell me she was incredibly sweet) and that it was just a "case" - I am not sure I am explaining it well, but basically it felt like they have removed all emotion from the situation and they might as well have been working on a toaster.

So I have become that owner that isn't compliant.. but it isn't because I don't care or it is "too hard".. it is because I honestly believe it is in her best interest. If we lose her over it I believe we are both okay with that. We will probably do the "what ifs" but I am checking in with her every hour or two while I'm awake to make sure I don't miss anything and while she is still a little tired, she is a darn site closer to 'normal' then she has been in a long while. If she shows ANY sign of back sliding I will run her to the vet and we can revisit the antibiotics and pain meds. If she continues to improve we will do a recheck in a week or so (they recommend two weeks and that was from this weekend) and I'll have them recheck her folate levels to see if we are dealing with malabsorption. I think if her levels are low I'll have them check Skippy's levels too to see if it isn't an issue with the recipe I'm using. I'm inclined to believe that the low level is from not eating for a long period of time, but I have no rational reason for believing that either. Time and more blood tests will tell.

I am beyond tired. I barely have had time to recover from moving and frankly I still have boxes laying around the house. I am so drained that I am having issues with my allergies so they are waking me up in the night.. Some serious self care is going to be called for her once we have the follow up and we have good news and I can stop worrying so much (ha ha ha) about things going south.. for now I have to settle for huffing kittens.. (update about the kittens tomorrow)

23 comments:

  1. HUGS <3

    Twee be strong and fight!

    Emma and Buster

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  2. I’m sorry you and Twee had this experience. Sometimes these big clinics just don’t get it. Having been there with Wally I can relate, but my experience was better. I’m hoping that Twee continues to improve. And if I can help in any way, let me know. ~Island Cat Mom

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  3. You have good instincts, and Twee is one tough girl. I'm so sorry to hear Angell communicated so poorly. I've heard good things about them in the past. It's true that any clinic can do a bad job with a single case even though they are usually stellar, but that doesn't help if you're that one case. We're sending good thoughts to Twee and hoping you can all get some rest soon!

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  4. The situation sucked and I'm sorry and angry about it. As I learned from my recent experience with Harris's broken toes, Angell's specialists are outstanding, but there's an intentional layer of young student-residents between them and us. Getting past that layer can be hard but it's necessary if you have a serious issue, have "complex" questions, and/or want to weigh your options with a highly experienced pro. Based on what happened to you and Twee, it appears that none of that is possible on weekends and evenings. You had a perfect storm of bad timing: driving in late on a Friday afternoon, and then no choice but to leave her with the youngsters on weekend duty. Twee is lucky you have the experience. brains, and instincts to figure out what's best for her yourself. But you shouldn't have had to do that: Angell is supposed to be way the heck better than this. It may be time to switch to Blue Pearl, which is also 24/7 emergency care but is NOT a teaching hospital.

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  5. I am so sorry you are going through such a stressful situation. I would be besides myself. I pray Twee continues to improve and you get great news. Twee is a survivor and so are you, dear Connie.

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  6. Paws crossed that Twee gets through this difficult period. It's so frustrating when clinics don't give you what you really need (I think you know what I mean). Binga's been going through a rough patch (happens with geriatric cats), and my human has been seeing it through without any vet intervention because she knows all they will do is set her up with a bunch of expensive tests that will be inconclusive (long experience has taught her that). So far, it looks like she's been through the worst of it and is doing better.

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    1. I am completely okay with tests and diagnostics but when the answer isn't going to change regardless of what you find they are pointless. When Kit's lump developed in her throat her vet at the time wouldn't talk about anything until they had a biopsy. I went for a second opinion and they walked through all of the possible senarios with me and also threw out there that it could be something out of left field. Most of the treatments for the things they could find was antibiotics and steroids.. the others were surgery and if that was the option her chances were minimal. So instead of putting her through blood work and then another car ride for surgery and another car ride for followups for a poor chance we opted for steroids and antibiotics. It is sad that too many vets have forgotten there used to be a time when ultrasounds didn't exist and what were the options without them. If the results of the different options vary dramatically and it could make a dramatic difference in the outcome of treatment, then ultrasounds are absolutely warranted if you can afford it.

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  7. We hope that Twee continues to improve and will keep purraying for her, and for you. Situations like this are so draining. Cats are especially medically complex. As far as the other vet, so many medical people are just technicians, not healers.

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  8. I continue to send prayers and positive thoughts for Twee and for you and your husband. Twee is in good hands.

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  9. Our purrs and purrayers to Twee and to you and your husband, we hope she continues to improve and that she bounces back fully. Whatever happens, you are doing what you feel is best for her, and in the end, that's all you can do. Hugs.

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  10. Sending healing thoughts for Twee and for you as well. Hopefully thinks will ease up soon.

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  11. YOU are Twee’s advocate, and you know her better than ANY vet, regardless of their tests and such. It’s awful to have the Angell folks be so unresponsive, and then you get to pay them for the pleasure! I trust YOU, and so does Twee. Your pure love trumps any vet knowledge.

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  12. There have been a few times I haven't followed vets instructions, especially with meditation, and it turned out ok. Instincts are there for a reason, too. I hope she continues to get better. Are you able to give her B vitamin injections at home?

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  13. it is SO frustrating that certain places get stuck in that routine of "read what is in front of me" rather than deal with the PERSON and the PET. that said, Twee is in great hands and we know you will do what is best for HER. purrs

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  14. It sucks when multiple cats develop problems, whether the problems come all at once or in series (as they did in this case). We had a similar situation within the last few months. You just have to listen to your experience and intuition. It sounds like you have a pretty good handle on the situation.

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  15. Your intuition is likely correct, as you know it usually is. She put on weight. If they are really in failure that doesn't happen. Possibly the constant IV fluids set her system back onto a good course and she took it from there with the help of digestive aids. I have sometimes met with that same sort of experience at the emergency hospital I typically go to, and other times it's opposite. It depends who you get.

    As for the cause, possibly she was absorbing your husband's grief for Jack and his grief for you and it was just too much for her little system. I was convinced I was loosing my tortie Cookie, 19, the week my mother was dying because Cookie had always been my little emotional sponge. She let me know she needed reiki in a very specific way, I did that, and I came home to a vibrant Cookie. At her age I was probably too much. I continued reiki when she needed it after that. Also, a friend almost lost her young rescued cat to some bizarre wasting, down to half her weight, though she was hungry, no cause after many tests. The emergency hospital, to be her last try and likely euthanasia, suggested a feeding tube. While she was under anesthesia they examined her mouth and throat and found a mostly healed blister under her tongue that had probably been very painful. She reacted well to the feeding tube, the blister healed, and she went back to normal life.

    More purrs for Twee!

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  16. we are sorry you have to go thru this; sorry isn't going to "help" but please know we care....st francis' blessings to you Twee; God's strength to you Connie and your husband ~~~~~

    instinct knows best in more situations than we give it credit for, and sometimes going outside and screaming at the top of your lungs helps too, ta hell with what the neighbors think ~~~~~~~~♥♥♥

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  17. Bless you and your husband and Twee - and all your other kitties. Without the insertion of the Medicare Bureaucracy. Keep om keeping on. It seems Twee has done amazing bounce back in the last week. She seems to be wanting to fight too.

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  18. Webbthistle6:56 PM

    My heart is with Twee and you and your husband. I am shocked/not shocked by the experience you had with Angell - it has a great reputation, but there is that barrier of vet trainees between you and the experts. I pray Twee continues to improve and that this horrible time will be over soon for all of you. Please take care of yourselves, as well as Twee, the other cats and the babies!

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  19. Purrs for Twee and mom bean sends her best as you manage this tough time. We hope Twee if feeling better soon, and you are too.

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  20. Would never go back to Angele if I was you. Vets need to show some compassion and empathy, and you have to trust them. I have one question. Is Twee on an anti-inflammatory? Sounds as if that should be in the mix. Wishing her and you well and will keep youth in mr prayers. XOCK, angel Lily Olivia, Mauricio, Misty May, Giulietta, angel Fiona, Astrid, Lisbeth, Calista Jo, Cooper Murphy and Sawyer

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    Replies
    1. I gave her cbd for a few days.. but when her improvement was on a completely upward trajectory I stopped because she really hates having liquid put in her mouth. She is on Denamarin and fluids right now..

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    2. Wow, that is great news about Twee. I pray she continues to improve.

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